The purpose statement is to assess the course of the COVID-19 pandemic and its impact on the epidemics of HIV infection, viral hepatitis C (HCV), tuberculosis, influenza, and acute respiratory infections in the North-Western Federal District (NWFD) of the Russian Federation during two years of spreading COVID-19 from the standpoint of the possible formation of syndemia or interference between pathogens.

Materials and methods. Data collection on HIV infection and HCV was carried out by Pasteur Research Institute of Epidemiology and Microbiology at St. Petersburg Medical Information and Analytical Center using data from federal state statistical observation forms and our own research materials. The indicators of excess mortality from all causes for 2020 in the Northwestern Federal District (NWFD) and in the Russian Federation were analyzed according to the data of the Federal State Statistics Service (ROSSTAT). The results of epidemiological surveillance of HIV infection, viral hepatitis C (HCV), and tuberculosis in the Russian Federation and in the NWED in 2020 and 2021 in comparison with previous years are summarized. Studies of influenza and SARS were carried out by Smorodintsev Research Institute of Influenza and Gamaleya National Research Center for Epidemiology and Microbiology in cooperation with regional support bases. PCR detection of ARVI pathogens was carried out.

Results and discussion. An analysis of epidemic indicators across the territories of the Northwestern Federal District of the Russian Federation made it possible to identify the following features: heterogeneity of the incidence of COVID-19 in the population in terms of time and intensity; the prevalence of morbidity in the metropolis (St. Petersburg) and industrial northern regions (the republics of Karelia and Komi). In a comparative aspect, the NWFD belongs to regions with high morbidity and mortality in the Russian Federation. St. Petersburg (378 deaths per 100,000 people in 2021) ranks second after Moscow. In turn, the Vologda, Murmansk, and Arkhangelsk regions, as well as the Komi Republic are among the top ten of the most affected subjects of the Russian Federation in the country. In terms of mortality, St. Petersburg was significantly ahead of all other subjects of the Russian Federation and the national average, which had several probable reasons. The first and second years of the pandemic did not reveal significant changes in epidemic rates of morbidity and mortality from other socially significant infections — HIV, HCV, and tuberculosis at the population level characteristic interference of viruses, where SARS-CoV-2 took the place of interfering, and influenza and SARS pretending or interfering pathogens. It took several months until the beginning of winter 2020 to crowd out seasonal respiratory infections by SARS-CoV-2. Then SARS-CoV-2 tightly captured the epidemic space, leaving no room for traditional respiratory infections, which accounted for less than 5% in early 2022.

Conclusion. The COVID-19 epidemic had pronounced developmental features with higher morbidity and mortality in the metropolis and other industrial centers. The pandemic did not significantly affect the patterns of the epidemic course of HIV, HCV, and tuberculosis, which rejected the presence of a syndemic between these pathogens. Interference with respiratory infections — influenza and SARS — was revealed with a clear predominance of SARS-CoV-2. 

The review analyzes the prevalence and pathogenetic aspects of HIV infection. The main clinical and morphological variants of kidney damage in HIV infection are outlined. The prevalence of kidney damage in HIV infection is 20–30%, which are represented by such clinical and morphological variants as HIV-associated nephropathy (VAN), immunocomplex HIV-associated kidney disease, and thrombotic microangiopathy. In patients with HIV infection who are not treated with antiretroviral therapy (ART) the most common type of kidney disease is HIVAT. A decrease in the number of CD4+ cells, high viral load, advanced age, and the presence of kidney pathology in the next of kin are risk factors for the development of HIVAT. Specific risk factors for kidney damage in HIV infection are the use of antiretroviral drugs (tenofovir), the uncontrolled use of which is accompanied by tubular dysfunction. In HIV infection, the degree of immunodeficiency correlates with the severity of kidney damage. The most common histopathological manifestations of kidney damage in individuals with HIV infection are focal segmental glomerulosclerosis, membranoproliferative glomerulonephritis, immunoglobulin A nephropathy, and mesangioproliferative glomerulonephritis. Hypertension, nephrotic syndrome, and reduced CD4+ cells are predictive of renal failure in HIV infection. In patients with HIV infection who are treated with ART the appearance of hypokalemia, nocturia, polyuria, microhematuria, and/or subnephrotic proteinuria is indicative of tubulointerstitial disease. To assess the total filtration function of the kidneys in people with HIV infection, the most acceptable formula is CKD-EPI. 

The purpose statement is to study the medical and social status and radiological changes in the CNS in women of reproductive age with HIV/HCV co-infection.

Materials and methods. The main group (n=36) consisted of patients with HIV/HCV and co-infection. The comparison group (n=36) consisted of women infected with HIV only. Within the framework of this study, clinical, laboratory (general clinical, biochemical, immunological, virological), and instrumental methods of research were used. All women with HIV/HCV and coinfection underwent indirect liver elastometry. The list of radiation research methods included PET/CT with FDG and MRI of the brain. Statistical processing and comparison of the results was carried out using MS Excel 2010 and GraphPad Prism 8 (GraphPad Software, Inc., USA) in accordance with the standards of mathematical statistics. The criterion of statistical significance of the findings was the value of p<0.01. Results and discussion. According to the criteria for inclusion in the study, patients in the comparison groups had an acceptable level of social adaptation, satisfactory indicators of the immune status, in 2⁄3 cases they achieved virological suppression against the background of antiretroviral therapy. HCV RNA was detected in 25 women (69.4%), pronounced manifestations of fibrotic changes in the liver were found in 6 (12.8%) patients. Radiation studies of the CNS revealed structural changes in 1⁄3 of cases, disorders of glucose metabolism of various localizations in all women with HIV/CHC. In patients with co-infection, compared with women infected with HIV, hypometabolism of glucose in various parts of the brain is significantly more often detected. Conclusion. As a result of a comprehensive clinical and neuroimaging examination, certain changes in the metabolic function of the brain were identified, which are characteristic of women with HIV/HCV co-infection. The use of PET/CT with FDG in some cases makes it possible to detect preclinical signs of VANR, as well as possible early manifestations of neurological disorders. Key words: human immunodeficiency virus, viral hepatitis C, HCV, chronic hepatitis C, CHC, women of reproductive age, central nervous system, PET, MRI, structural changes, metabolic disorders>˂ 0.01.

Results and discussion. According to the criteria for inclusion in the study, patients in the comparison groups had an acceptable level of social adaptation, satisfactory indicators of the immune status, in 2⁄3 cases they achieved virological suppression against the background of antiretroviral therapy. HCV RNA was detected in 25 women (69.4%), pronounced manifestations of fibrotic changes in the liver were found in 6 (12.8%) patients. Radiation studies of the CNS revealed structural changes in 1⁄3 of cases, disorders of glucose metabolism of various localizations in all women with HIV/CHC. In patients with co-infection, compared with women infected with HIV, hypometabolism of glucose in various parts of the brain is significantly more often detected.

Conclusion. As a result of a comprehensive clinical and neuroimaging examination, certain changes in the metabolic function of the brain were identified, which are characteristic of women with HIV/HCV co-infection. The use of PET/CT with FDG in some cases makes it possible to detect preclinical signs of VANR, as well as possible early manifestations of neurological disorders. 

The aim of this study was to estimate the prevalence of hepatitis B and D viruses among HIV-infected residents of South Vietnam.

Materials and methods. The study material was represented by 316 blood serum samples collected from HIV-infected residents of the Socialist Republic of Vietnam taking antiretroviral therapy. The subjects were examined for the presence of HBV markers with a qualitative detection of HBsAg, HBs IgG, HBcore IgG, anti-HDV, DNA HBV, and RNA HDV. HBV and HDV complete genomes nucleotide sequences were obtained for 23 samples from HIV+HBV+HDV co-infected patients. Amplification and subsequent sequencing of HBV and HDV were performed using nested PCR with pair’s overlapping primers jointly flanking the complete HBV and HDV genomes, respectively.

Results. Serological markers of HBV and HDV were presented in the following ratios: HBsAg — 9.17%, anti-HBs Ig G — 10.44%, anti-HBcore Ig G — 42.08%, total anti-HDV — 9.81%. HBV DNA was detected in 32.58% of cases, including 23.41% of HBsAg-negative individuals. HDV RNA was detected in 24.13% of HBsAg-positive individuals and 21.62% of HBsAg-negative, which amounted to 22.33% of HBV-positive individuals and 7.27% of the total group, respectively. In phylogenetic analysis, HBV subgenotype B4 (60.89%) prevailed among HIV-infected patients compared to C1 (21.73%), B2 (8.7%), C2 (4.34%) and C5 (4.34%). Phylogenetic analysis of HDV nucleotide sequences showed the prevalence of HDV genotype 1 (78.26%) compared to genotype 2 (21.74%). The hepatitis Delta virus prevalence in patients with HIV+HBV coinfection, and the prevalence of seronegative HDV in patients with OBI indicate the need to use PCR in hepatitis highly endemic regions for hepatitis B and hepatitis D screening of the general population and especially those at-risk groups. 

The purpose of the study: to analyze the microbiota of the vagina and urine culture in HIV-infected women, depending on the absence or presence of pre-pregnancy preparation with and without a partner.

Materials and methods. 90 women of reproductive age with stage 3 and 4A of HIV infection participated. Vaginal fluid and urine were inoculated on artificial nutrient media, identification using MALDI ToF mass spectrometry. The Kraskel-Wallis criterion, Mann-Whitney criterion and Simpson index were used to compare the groups.

Results and their discussion. It was found out that in women without pregravidar preparation, the total bacterial mass of lactobacilli is significantly lower (p=0.004), the total number of lactobacilli is lower (p=0.005); the bacterial mass of staphylococci and streptococci is greater (p=0.009); the total number of microorganisms seeded is higher (p=0.004) against the background of increased viral load (p=0.001); Enteroccocus often acts as the cause of asymptomatic bacteriuria faecalis with a viral load above the detection threshold (p=0.009). Thus, we show that the lack of pre-pregnancy preparation in HIV-infected women is associated with vaginal mesocenosis and the development of asymptomatic bacteriuria. 

The purpose statement is to analyze the socio-demographic, clinical, epidemiological, and behavioral characteristics of patients with only HIV infection and those co-infected with HIV and Tr. pallidum, which are under supervision in St. Petersburg GBUZ «Center for the Prevention and Control of AIDS and Infectious Diseases».

Material and methods. The data of outpatient cards of 588 patients who were registered in the dispensary at the St. Petersburg Central Clinical Center in the period from 2018 to 2020 were studied, and the data of the cards of males (435 people) were selected. Patients were divided into two groups: with HIV monoinfection (198 people) and with a combination of HIV infection and syphilis (237 people).

Results. Patients co-infected compared with HIV-only patients were less likely to have higher education, were less likely to be married, were diagnosed with HIV infection more often at self-report and during routine examination, there were more men who hade sex with men (homosexual), and bisexual men. Co-infected patients were less likely to have used drugs in the present or in the past and were primarily infected with HIV through sexual contact. They were diagnosed mainly with early forms of syphilis. In patients with coinfection, concomitant diseases of the kidneys, cardiovascular, endocrine systems were often detected, and a high comorbidity with chronic hepatitis B was also noted.

Conclusion. The identified socio-demographic, clinical, epidemiological and behavioral characteristics of men with HIV + syphilis coinfection indicate the need for more active work aimed at popularizing barrier contraception among men, especially MSM and prone to bisexual contacts; when syphilis is detected in HIV-infected patients, conduct a thorough examination of all organs and systems, extraordinary for the presence of viral hepatitis. 

Every year, about a fifth of the Russian population undergoes laboratory testing for HIV infection, which creates a significant burden on the healthcare system. A significant part of the research on markers of HIV infection is performed using ELISA test systems, usually using manual labor of personnel. The decision to automate this process should be based on the results of a comparative analysis of the direct costs of manual and automated methods.

The purpose statement is to evaluate the impact of automation on the labor intensity and cost of ELISA tests for antibodies to HIV1.2 / p24 antigen, depending on changes in the number of laboratory tests and the mode of operation of automatic equipment.

Materials and methods. The study of costs was carried out for the manual ELISA method and for automated execution using the ELISA analyzer «Lazurit». To analyze the labor costs of the personnel, the timing of the workplaces of the medical laboratory was performed. When modeling various flows of biomaterial samples, the number of laboratory tests was used, which is a multiple of the 1st plate of the ELISA test system. The assessment of the influence of the operating modes of the automatic analyzer was carried out with a working shift of 7.2 hours and 12 hours.

Results. Automation of ELISA in conditions of medium and large volumes of testing saves labor by more than 1.6 times with a work schedule of 7.2 hours, and more than 1.9 times with a schedule of 12 hours. At the same time, automation increases the technological cost at low flows by more than 2 times, and at high flows — by 1.2 times. Conclusion. Automation of HIV testing using an ELISA analyzer leads, in general, to a negative economic effect due to a significant excess of the cost of additional consumables and depreciation of equipment over the possible savings in the wage fund. However, with a load exceeding 3–4 ELISA plates per day per 1 medical laboratory technician, automation can be an effective alternative to increasing the laboratory staff. Optimal for automated ELISA at medium and high flows is a 12-hour work schedule. 

Introduction. Forecasting of different processes in health, including epidemics, are important area of public health. There exists an idea that in some cases simple models can give adequate forecasts.

Goal of this study was to evaluate possible use and results of forecasting of registration of new cases of HIV infection in Russian Federation based on well-known Farr’s law.

Materials and methods. The official statistical data on new HIV cases in 1999–2020 in Russian Federation were used. Parameters for forecasting new cases until 2027 were calculated according to Bregman and Langmuir. For evaluation of forecasting the calculations were done for 2015–2020 after fitting model with data until 2014. Normal components of the empirical epidemic curve were estimated and more appropriately fitted distributions were found for the data described by those components.

Results. Estimations according to the Farr’s law somewhat undercount number of the new cases of HIV infection (it forecast 99% (95% CI 92–106%) cases when smoothing was used and 97% (95% CI 89–106%) when raw data were used). In general, especially when smoothing was used, fit was satisfactory. Forecast until 2027 show that total number of HIV cases in 1999–2027 will be 1.7–2.0 mln people. Analysis of most probable distribution of the second peak of epidemic curve show that it is lognormal, which allow for much larger number of infected in medium- and long-term perspective.

Conclusion. Though Farr’s law could be used for short-term forecast it is not recommended to weaken preventive programs due to possibility of large increase in number of HIV-infected in comparison with Farr’s law forecast. 

The purpose statement is to identify and assess the risk factors determined by the development of the epidemic process of HIV infection in the area of high concentration of the risk group.

Object of study. 365 deceased HIV-infected were identified, of which: the study group — 222 prisoners who died HIV-infected on the basis of the Regional Hospital of the Federal Penitentiary Service of the city of Tyumen for the period 2008–2018; control group — 143 civilian (law-abiding) patients who died HIVinfected on the basis of the Regional Infectious Diseases Hospital for the period 2011–2018.

Research methods. The work used the methods of epidemiological research, mathematical modeling and forecasting, logistic regression of stepwise inclusion with ROC analysis.

Results. To assess the epidemiological situation in relation to the incidence of HIV infection in places of detention, the longterm dynamics of the development of the epidemic process was studied with an assessment of priority risk factors, forecasting the development of the epidemic process of HIV infection with the establishment of social significance and risk for the civilian population over a long period. The probability of developing a fatal outcome in HIV-positive men serving sentences is 4.7 times higher than among civilian men, while 14.6 times higher when infected with HIV by parenteral (narcotic) infection, 4.8 times higher with concomitant viral hepatitis and 20 times higher in the presence of a respiratory disease, 99.2% higher in the clinical stages of HIV infection 3, 4A, 4B than in civilians.

Conclusion. Prisoners have an unfavorable situation for HIV infection with high mortality. A set of organizational and preventive measures to prevent the spread of HIV among prisoners at the present stage should be strengthened with an emphasis on groups at increased risk and progression of infection. 

The purpose statement is to study the course of COVID-19 in patients with HIV infection and morphological changes in the lungs with their combined SARS-CoV-2 and secondary infections.

Materials and methods: The study included 96 patients with HIV infection and SARS-CoV-2 infection confirmed by PCR, aged 26 to 54 years. The clinical manifestations, the content of CD4-lymphocytes and HIV RNA, the presence of secondary infections, and morphological changes in the lungs were studied.

Results and discussion: In patients with HIV infection with moderate or severe immunodeficiency, a mild course of COVID19 (63.2%) was observed more often than in patients without immunodeficiency (14.3%). Four out of 9 patients with severe immunodeficiency developed a combined lesion of the lung tissue (SARS-CoV-2 + CMV and SARS-CoV-2 + Pneumocystis carinii) with a fatal outcome.

Conclusion: In the diagnosis and treatment of COVID-19 in patients with HIV infection, it is necessary to take into account the severity of immunodeficiency and viral load. 

The study is devoted to the study of the emotional state of people in the conditions of self-isolation during the pandemic of a new coronavirus infection. The online study involved 380 «conditionally healthy» respondents aged 18 to 60 years. A special questionnaire was developed; to assess the emotional state of the subjects, the Hospital Anxiety and Depression Scale (HADS) and the Bass-Darkey aggressiveness level questionnaire were used. Only 45–54% of respondents tried to comply with the sanitary regime, men violated the established requirements more often than women. No clinical symptoms of anxiety or depression were found. The level of anxiety reached subclinical values in women. At the same time, there was an increased level of aggression (verbal and indirect) and irritation, an increase in the integral indicators of aggressiveness and hostility. These emotional manifestations characterize the well-known reactions of a person’s mental maladaptation in difficult life situations. 

Purpose. Development of complex diagnostic methods and assessment of the course of allergic diseases in immunocompromised individuals with HIV infection based on the use of actual computer technologies to improve the quality of diagnostics and treatment measures in these patients.

Materials and methods. Methods for calculating the relative increase and average growth rate used to estimate the annual increase in the number of diagnosed cases of allergic diseases in the Novgorod region. During the studying of the comorbidity of HIV and allergy we used information about a burdened allergic history. Additional parameters of the analysis were data, obtained in clinical laboratory. For analysis of the data we used Student’s t test (t) and Pearson’s x². The study used the principle of a diagnostic matrix, which allows transferring medical experience to IT solutions, such as DSS and their variants.

Results. In the Novgorod region there has been an increase in the number of diagnosed cases of individual allergic diseases. Over 1020 registered cases of HIV infection among residents of the Novgorod region considered to study the comorbidity of HIV infection and allergies. Information about aggravated allergic anamnesis is indicated in 12% cases. Statistically significant (p<0.012) correlation between high viral load and the development of drug allergy in HIV-infected patients with identified allergic pathology were shown. The indicators of the immune status showing specific markers of allergy in patients with HIV were studied. We developed the clinical decision support system (CDDS), which used to organize medical knowledge and optimize the diagnostics.>˂ 0.012) correlation between high viral load and the development of drug allergy in HIV-infected patients with identified allergic pathology were shown. The indicators of the immune status showing specific markers of allergy in patients with HIV were studied. We developed the clinical decision support system (CDDS), which used to organize medical knowledge and optimize the diagnostics.